三维CT血管造影在破裂动脉瘤筛查中的应用价值

Value of three dimensional computed tomography angiography on ruptured intracranial aneurysms

目的 探讨16排螺旋三维CT血管造影（3D—CTA）在诊断破裂动脉瘤中的应用价值。方法 对38例可疑动脉瘤性蛛网膜下腔出血（SAH）患者行3D—CTA检查，应用表面遮盖、最大密度投影等重建技术，15例行数字减影血管造影（DSA）检查，将得到的影像学资料与手术所见进行对比分析。结果 34例患者确诊为动脉瘤，共发现动脉瘤38个，其中多发性动脉瘤4例。3D—CTA可以清晰显示瘤体、瘤颈、载瘤动脉与周围结构的关系。将3D—CTA与DSA检查测量的瘤体及瘤颈数据进行比较，差异无统计学意义（P〉0．05）。显微手术治疗23例，介入栓塞治疗7例。结论 16排螺旋3D—CTA图像质量高，可作为SAH及可疑动脉瘤患者的首选筛查方法，DSA可作为必要的补充检查手段。

Objective To evaluate the clinical value of 16 - slice spiral CT three - dimensional computerized tomography angiography （3D- CTA） in diagnosis of ruptured intracranial aneurysms. Methods 3D - CTA was performed in 38 patients suspected of aneurismal subarachnoid hemorrhage （SAH）. Maximum intensity projection （MIP） and surface shaded display （SSD） techniques were used to reconstruct 3D images. Fifteen patients of them received intra - arterial digital subtraction angiography （DSA） examination. The results of 3D - CTA, DSA and interoperation were compared. Results A total of 38 aneurysms in 34 patients were detected by 3D -CTA, which were confirmed by operation and 4 were multiple aneurysms. Aneurysms body, neck, source vessel and the relationship between the aneurysms and surrounding structures were clearly and surely displayed in 36 cases. In these cases, there was no statistic difference between the measurements of 3D - CTA and DSA about the size of the aneurysms neck and body （ P 〉 0.05 ）. Microsurgery treatment was performed in 23 cases, and embelization in 7 cases. A good correlation between 3D - CTA and the intra - operative findings was present in 23 cases. Conclusion The quality of the image of 16 - slice spiral CTA is perfect, and the diagnostic accuracy is promising and appears equivalent to that DSA for detection and evaluation of intracranial aneurysms. A strategy of using CTA as the first choice, with DSA reserved for cases of uncertainty, appears to be practical and safe.